Dataset Information

Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time.

ABSTRACT:

Importance

Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time.

Objective

To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time.

Design, setting, and participants

This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020.

Exposures

P2P support, provided by trained older adult volunteers.

Main outcomes and measures

Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group.

Results

A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life.

Conclusions and relevance

These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.

SUBMITTER: Schwei RJ

PROVIDER: S-EPMC8207241 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ImportanceThe vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place.ObjectiveTo investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults.Design, setting, and participantsThis comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020.ExposuresP2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments.Main outcomes and measuresRates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up.ResultsA total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study.Conclusions and relevanceP2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.

Project description:Importance:Disparities in health insurance coverage by immigration status are well documented; however, there are few data comparing long-term changes in insurance coverage between immigrant and nonimmigrant adults as they age into older adulthood. Objective:To compare longitudinal changes in insurance coverage over 24 years of follow-up between recent immigrant, early immigrant, and nonimmigrant adults in the US. Design, Setting, and Participants:This population-based cohort study used data from the nationally representative Health and Retirement Study. Data were collected biennially from 1992 to 2016. The population included community-dwelling US adults born between 1931 and 1941 and aged 51 to 61 years at baseline. Statistical analysis was performed from February 3, 2017, to January 10, 2020. Exposures:Participants were categorized as nonimmigrants (born in the US), early immigrants (immigrated to the US before the age of 18 years), and recent immigrants (immigrated to the US from the age of 18 years onward). Main Outcomes and Measures:Self-reported data on public, employer, long-term care, and other private insurance were used to define any insurance coverage. Longitudinal changes in insurance coverage were examined over time by immigration status using generalized estimating equations accounting for inverse probability of attrition weights. The association between immigration status and continuous insurance coverage was also evaluated. Results:A total of 9691 participants were included (mean [SD] age, 56.0 [3.2] years; 5111 [52.6%] female). Nonimmigrants composed 90% (n = 8649) of the cohort; early immigrants, 2% (n = 201); and recent immigrants, 8% (n = 841). Insurance coverage increased from 68%, 83%, and 86% of recent immigrant, early immigrant, and nonimmigrant older adults, respectively, in 1992 to 97%, 100%, and 99% in 2016. After accounting for selective attrition, recent immigrants were 15% less likely than nonimmigrants to have any insurance at baseline (risk ratio, 0.85; 95% CI, 0.82-0.88), driven by lower rates of private insurance. However, disparities in insurance decreased incrementally over time and were eliminated, such that insurance coverage rates were similar between groups as participants attained Medicare age eligibility. Furthermore, recent immigrants were less likely than nonimmigrants to be continuously insured (risk ratio, 0.89; 95% CI, 0.85-0.94). Conclusions and Relevance:Among community-dwelling adults who were not age eligible for Medicare, recent immigrants had lower rates of health insurance, but this disparity was eliminated over the 24-year follow-up period because of uptake of public insurance among all participants. Future studies should evaluate policies and health care reforms aimed at reducing disparities among vulnerable populations such as recent immigrants who are not age eligible for Medicare.

Project description:ImportanceResearchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.ObjectivesTo evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.Design, setting, and participantsThis cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.ExposureAging satisfaction.Main outcomes and measuresA total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.ResultsDuring the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.Conclusions and relevanceThis study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.